Medicare Advantage plans are sold by private insurance companies. They are required to cover everything that Original Medicare, Part A and Part B, does. Under a Medicare Advantage plan, you get your Original Medicare coverage through the plan instead of directly through Medicare.
If you join Medicare Advantage, you aren’t leaving the federal Medicare program. You actually remain enrolled in Medicare Part A and Part B, and some of your benefits, like hospice care, are covered through Original Medicare, even if you join a Medicare Advantage plan.
In many cases, Medicare Advantage plans include networks of clinics, doctors, and hospitals. If you belong to one of these plans, then you may need to seek treatment from providers within that network, or risk paying considerably more in out-of-pocket spending.
Besides offering the Original Medicare coverage mentioned above, Medicare Advantage plans may include additional benefits, like vision, dental, and hearing.
There are several different Medicare Advantage options, although not every plan type may be available in your area. We recommend that you compare the available options, as each plan’s coverage details may differ. Consider all your current health care needs before making a decision. You may also wish to consult your doctor and other health care providers to see what they recommend in terms of your coverage scope.
There are several types of Medicare Advantage plans; here’s a brief explanation of the more common types.
Medicare Preferred Provider Organization (PPO)–A network of doctors, clinics, hospitals, and other health care providers. With this type of plan, you don’t have to choose a primary care physician up front to coordinate your care. Instead, you can see any doctor or specialist. If you go to providers outside your PPO network, your out-of-pocket costs may increase.
Medicare Health Maintenance Organization (HMO)–A plan in which you choose a primary care physician who will coordinate your care and refer you to any specialists you have to see. An HMO typically has a network of health-care professionals, and going outside of that network could require you to pay completely out-of-pocket for any services.
Medicare Private Fee-for-Service (PFFS)–A type of Medicare Advantage plan in which the plan, not Medicare, sets payment terms. If the doctor or health care provider accepts PFFS’s terms, fees, and conditions, then you can see any doctor or specialist without worrying about network restrictions.
Medicare Special Needs Plans (SNPs)–Plans designed for people with certain chronic diseases or other special health needs. All of these plans must include Medicare Part A and Part B coverage as well as prescription drug coverage.
Medicare Medical Savings Account (MSA)–Plans consisting of two parts:
Not all Medicare Advantage plans include prescription medication coverage, but most do. When comparing plans, ask the plan (or review its description) to make sure it includes drug coverage if that coverage is important to you.
To be eligible for Medicare Advantage, you must already be enrolled in Original Medicare, Part A and Part B. You must continue paying your Part B premium, along with any premium your Part C plan may charge. You must live within the plan’s network, and in most cases you’re not eligible if you have end-stage renal disease.
To join a Medicare Part C plan, you can take advantage of certain enrollment periods.
The Initial Coverage Election Period (ICEP) is when you’re first eligible for a Medicare Advantage plan.
When you become eligible for Medicare and you’re enrolled in Medicare Part A and Part B, you can join a Medicare Advantage plan. In this case, your ICEP is the seven-month period that starts three months before the month where you turn 65, runs through your birth month, and continues for the three months after that. This is the same as your Medicare Initial Enrollment Period.
If you don’t sign up for Medicare Part B when you’re first eligible (for example, if you’re covered through an employer’s plan), your ICEP is the 3-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your ICEP would be April 1 to June 30.
Your next chance to join a Medicare Advantage plan is during the Annual Election Period, also called the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. It runs from October 15 to December 7 each year. You can add, change, or drop Part C plans during the AEP, and your new coverage starts on January 1 of the following year.
If you have Original Medicare, you can also add stand-alone Medicare Part D prescription drug coverage during the Annual Election Period. If you’re already enrolled in a Medicare Advantage plan that doesn’t include drug coverage, you can’t add a stand-alone prescription drug plan without disenrolling from the Part C plan and returning to Original Medicare. If you have Part C without drug benefits and want prescription drug coverage, you usually have to switch to a Medicare Advantage Prescription Drug plan. (You can add Part D to certain types of Medicare Advantage plans, such as Private Fee-for-Service plans that don’t include drug coverage and Medicare Medical Savings Account plans.) Alternatively, you can leave your Part C plan, return to Original Medicare, and add a Part D plan.
In some situations, you can join a Part C plan during a Special Enrollment Period. Examples of these situations include (but are not limited to): moving to a new address, losing your current health coverage, qualifying for a different type of coverage, or experiencing changes in your current plan that affect your health benefits.
If you decide to drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B, you can do so during the Medicare Advantage Disenrollment Period, from January 1 to February 14 each year. You can also add a stand-alone Medicare Part D prescription drug plan during this time.
Medicare Advantage isn’t as complicated as it sounds. Before you decide on the type of Medicare insurance that works best for you, we recommend that you understand the coverage and costs, such as premiums, coinsurance, copayments, and deductibles. This isn’t guesswork; don’t be afraid to ask questions. A licensed Medicare representative can help you find the answers. For help finding a good plan for you, you can do any of the following:
Medicare has neither approved nor endorsed this information.